Summons and Complaint - Michigan free download and preview, download free printable template samples in PDF, Word and Excel formats Do not use the Printer Friendly button at the top of this page - clicking this button may cause you to lose any data you entered. Complaint Details/Inquiry By submitting this form, I certify that the information is true and accurate to the best of my knowledge. I wish to complain against the facility/agency/provider named below. Safety and Health Hazards Complaint Form. There is a maximum of two grievants per Request for Investigation form. I am submitting this information so that it may be determined if a licensing or a child welfare contract action against this facility/agency/provider should be considered. You may also write to us at 2966 Woodward Ave., Detroit, MI 48201, send us a fax at (313) 578-6811, or call us at (313) 578-6800 during our telephone intake hours between 1:00 p.m. … Use this form if . This is a business case in which all or part of the action includes a business or commercial dispute under MCL 600.8035. Walk-in: The Patient Relations & Clinical Risk office is located in University Hospital, Room UH 2B228. 0 Online Complaint Form - Division of Child Welfare Licensing It is important that you fill out the complaint form as complete as possible. Contact Patient Relations and Clinical Risk with concerns about: 1. Please read these instructions carefully. To begin a case, you must complete and file a vorce, a Complaint for DiRecord of 370 0 obj <>stream * I consent to releasing to the Michigan Attorney General any information or document relative to the investigation of this complaint. Every template is drafted and updated by state-accredited lawyers. The court must respond in writing to a grievance within five business days using the response section of form MC 98​. The hotline is open Monday - Friday from 8 a.m. to 5 p.m. E-license - Renew Health Professional License Online! endstream endobj 335 0 obj <>/Metadata 18 0 R/Names 357 0 R/OpenAction 336 0 R/Outlines 29 0 R/Pages 332 0 R/StructTreeRoot 33 0 R/Type/Catalog/ViewerPreferences<>>> endobj 336 0 obj <> endobj 337 0 obj <. However, if you do not provide it, a licensing consultant will not be able to contact you if additional information is needed. If you have already a subscription, log in. Call: 800-288-5923 Fax: 517-487-0827 LARA Bureau of Professional Licensing - Licensed Health Professionals The Bureau also handles complaints against licensed health … Your complaint may not be assigned or may be unconfirmed due to an inability to reach you for follow-up. The Michigan Department of Attorney General does not endorse or promote any of the products or sites listed on the following pages. Complete and submit an NAACP complaint form to the Greater Grand Rapids NAACP here, an advocacy group dedicated to fixing crumbling city infrastructure, criminal justice reform, and improving education, environment, and healthcare systems throughout Grand Rapids, MI and beyond. Michigan Department of Education, Office of Special Education Page 1 Request for a State Complaint Investigation Parents and other individuals and organizations may file a complaint if they believe a school district or other educational agency has violated one or more requirements of the Department of Insurance and Financial Services Online Complaint Form | DIFS - MiDIFS, Michigan Department of Insurance and Financial Services hÞb```b``–f`e`à½Ê Ā BÌ@QŽž•üìۀ‹s²³âÆ@a††Œ¨àf`ú ÖÇÀ 2€IÈpP½ dÛ3H`l`(aPfj`þÀPÁàÍz§q³ƒÂ[æüÇ0|€ØÊÃÀô©H3qó20}f„ð™nÃÝ&ÈÀÌ¡ eìÒ|L_ï if õ.`qF[E˜åk Ê gœ#} Member Complaint Form Complete and mail or fax to: Michigan Complete Health | Attention: Appeals & Grievances 7700 Forsyth Blvd | St Louis, MO | 63105 | Fax: 1-844-273-2671 Michigan Complete Health (Medicare-Medicaid Plan) will answer your complaint no later than 30 days from the date you submit your complaint. COMPLAINT Instruction: The following is information that is required to be in the caption of every complaint and is to be completed by the plaintiff. By submitting this form electronically, I certify that the information provided is complete and accurate to the best of my knowledge. hÞbbd``b`æŒßƒˆ$Xˀ“$ˆˆ CËD؀¸ÍpYs7HHv Y_ Á$¸@„À ÑÄÈÀÄÈxd#EĆeŸ r'E Although every effort is made to maintain accurate information on this site, the Michigan Supreme Court does not guarantee the accuracy of the information. Tweets by MichiganHHS COMPLAINT, TERMINATION OF TENANCY . (Your husband/wife does not need to live in the same county.) For the hearing impaired: Call the Michigan Relay Center at 1-800-649-3777. It is important that you fill out the complaint form as complete as possible. }, The Michigan Department of Health and Human Services (MDHHS). %%EOF max-height:500px; For all other complaints or an unlicensed complaint where you have additional concerns, answer the following questions, as applicable, regarding each concern. Michigan Complete Health Medicare-Medicaid Plan (MMP) will answer your complaint no later than 30 days from the date you submit your complaint. The Consumer Protection, Child Support, and Health Care Fraud Divisions of the Attorney General's office help consumers each year by mediating complaints that fall within our jurisdiction. Online: Concern form (secure and confiden… Online: Submit a complaint under Contact Us. Automotive Complaint Form. The information is updated frequently based upon the needs of our users. Actual allegations and the claim for relief must be stated on additional complaint pages and attached to this form. Form DC 102c. Only new complaints can be filed on the Web, using the link at the bottom of the page. The forms are filed in circuit court, district court, or probate court depending on their purpose. COMPLAINT TO RECOVER POSSESSION OF PROPERTY. ... Actual allegations and the claim for relief must be stated on additional complaint pages and attached to this form. I also certify that I understand that making a false complaint is a crime punishable by up to a $5,000 fine, imprisonment for up to four years, or both. When your complaint has been submitted, you will be informed of your … If you want to print a copy of this form after you've completed it, use the Print button at the bottom of this page. If you wish to request legal assistance from the ACLU of Michigan, we strongly urge you to submit your complaint to us online using the form below. Open for walk-in assistance Monday-Friday 8a.m.- 4p.m., or by appointment. Complaint and Notice for Health-Care Expense Payment: ... (Child Support/Parenting Time) (two-part form) ... Use of this site is at your own risk, and the Michigan Supreme Court will not be liable for any damages whatsoever resulting from the use of the information available on the site. 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Be as specific as possible. Summons and Complaint gives the Defendant 21 days to answer the Complaint if he or she is in Michigan and 28 days if he or she is out of state, and it puts the him or her on record as being informed of his or her rights. Submit this form to the court clerk along with your complaint and, if necessary, a case inventory addendum (form … The Michigan Supreme Court is providing the information on this site as a public service.